Autologous stem cell transplantation (ASCT) followed by consolidation chemotherapy for multiple myeloma (MM)

I. Gojo, A. Murthy, A. Passas, G. Tricot, R. Fenton, B. Mookerjee, B. Meisenberg, N. Takebe, S. R. Frankel, C. Sarkodee-Adoo, M. R. Heyman, K. Ruehle, R. Smith, T. Cher, A. Rapoport

Research output: Contribution to journalArticlepeer-review

Abstract

ASCT has improved CR and survival rates for patients with MM. However, relapses occur in the majority of transplant recipients. We hypothesized that administration of 4 cycles of post-transplant (PT) consolidation chemotherapy (CC) using non cross-resistant agents might delay or prevent disease progression. Between 10/97 and 5/00 82 patients (pts) with MM received CC after autografting; 78 pts with more than 6 months of follow up were analyzed. Mobilization chemotherapy consisted of cytoxan (4.5 gm/m2) in 28 pts, cytoxan (4.5 gm/m2) plus etoposide (2 gm/ma) in 47 pts and other regimens in 3 pts. Highdose therapy consisted of BCNU (300 mg/nr, day -2) and melphalan (140 mg/m2, day -1 ). A median of 7.32 x 106/kg CD+ 34 cells were infused (range: 1.1 -38.24). CC included DCEP i DEX (40 mg/day x 4), CTX (300 mg/m2 /day x 4), VP-16 (30 mg/mVday x 4), cisplatin ( 15 mg/nv/day x 4)] by continuous infusion at 3 & 9 months PT; and DEX (40mg/day, dl-4). taxol (135 mg/m2 over 6 hr, aï) and cisplatin (75 mg/nr over 24 hrs, d3) at 6 & 12 mos PT. G-CSF (5 Hg/kg) was given with each cycle. Gemcitabine was added to the conditioning regimen and to cycles #1 and #3 for the 15 pts diagnosed > 12 mos before transplant. 14, 9, 8 and 30 pts have completed 1, 2, 3 and 4 cycles of CC. Following transplant, 29 pts (37%) were in CR, 3 pts (3.8%) were in VGPR [90% decrease in M-protein], 13 pts were in PR (16.7%) and 19 pts (24%) had SD [stable disease]. Early transplant-related mortality (< 60 days) was 7.7%. During CC, grade 3-4 myelosuppression was common; 4 patients received stem cell boosts after CC#1 for prolonged thrombocytopenia after ASCT; 1 pt died after cycle #2 due to PCP and 1 pt had a grade 4 cellulitis. After a minimum of 6 mos follow-up, 32 pts were in CR (41%), 2 pts were in VGPR (2.5%), 7 pts were in PR (9%) had 5 pts (6.4%) had SD. CC led to incremental responses in 11 pts. The median overall survival (OS) has not been reached (Kaplan Maier [KM] 2.5 yr OS = 69%) while the median KM event-free survival (EPS) was 21.1 months. Predictors of better OS and EPS included normal cytogenetic results at diagnosis and a low 2-microglobulin level; a non-IgA subtype was also marginally associated with improved EPS. Post-transplant consolidation chemotherapy is feasible and generally well-tolerated after ASCT.

Original languageEnglish (US)
Pages (from-to)369b
JournalBlood
Volume96
Issue number11 PART II
StatePublished - Dec 1 2000

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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